AI Article Synopsis
- Pernicious anemia (PA) causes difficulty in absorbing vitamin B12 due to a lack of intrinsic factor, leading to the standard treatment of intramuscular injections, though oral supplementation has potential.
- This study evaluated the effectiveness of oral vitamin B12 supplementation on patients diagnosed with PA by measuring various plasma and urinary vitamin B12-related biomarkers over one year.
- Results revealed that after one month of oral supplementation, 88.5% of participants were no longer deficient in vitamin B12, with significant and sustained improvements in relevant biomarkers throughout the study, indicating oral supplementation may be a viable treatment option.
Article Abstract
Background: The absorption of vitamin B12 is hindered in pernicious anemia (PA) owing to intrinsic factor deficiency. Traditionally, intramuscular vitamin B12 injections were the standard treatment, bypassing the impaired absorption. Although there is potential for oral vitamin B12 supplementation through passive enteral absorption, it is not commonly prescribed in PA owing to limited studies assessing its efficacy.
Objectives: We aimed to assess the efficacy of oral vitamin B12 supplementation in PA.
Methods: We enrolled participants diagnosed with incident vitamin B12 deficiency related to PA. The diagnosis of PA was based on the presence of classical immune gastritis and of anti-intrinsic factor and/or antiparietal cell antibodies. To evaluate the vitamin B12 status, we measured total plasma vitamin B12, plasma homocysteine, and plasma methylmalonic acid (pMMA) concentration and urinary methylmalonic acid-to-creatinine ratio. Participants were treated with oral cyanocobalamin at a dosage of 1000 μg/d throughout the study duration. Clinical and biological vitamin B12 deficiency related features were prospectively and systematically assessed over the 1-y study duration.
Results: We included 26 patients with vitamin B12 deficiency revealing PA. Following 1 mo of oral vitamin B12 supplementation, 88.5% of patients were no longer deficient in vitamin B12, with significant improvement of plasma vitamin B12 [407 (297-485) compared with 148 (116-213) pmol/L; P < 0.0001], plasma homocysteine [13.5 (10.9-29.8) compared with 18.6 (13.7-46.8) μmol/L; P < 0.0001], and pMMA [0.24 (0.16-0.38) compared with 0.56 (0.28-1.09) pmol/L; P < 0.0001] concentrations than those at baseline. The enhancement of these biological parameters persisted throughout the 12-month follow-up, with no patients showing vitamin B12 deficiency by the end of the follow-up period. The median time to reverse initial vitamin B12 deficiency abnormalities ranged from 1 mo for hemolysis to 4 mo for mucosal symptoms.
Conclusions: Oral supplementation with 1000 μg/d of cyanocobalamin has been shown to improve vitamin B12 deficiency in PA.
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| http://dx.doi.org/10.1016/j.ajcnut.2024.05.019 | DOI Listing |
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